The SIKO Project will provide important practical information about how to improve treatment of AIDS-KS and thereby improve outcomes of antiretroviral treatment in Zimbabwe and other African countries that have a high burden of this cancer. This project will lead to improved medical practice, research and knowledge related to Zimbabwe and PEPFAR health priorities. PUBLIC HEALTH RELEVANCE: AIDS-associated Kaposi' sarcoma (AIDS-KS) is a cancer that is a major cause of morbidity and mortality in Africa. To realize the greatest possible benefits from antiretroviral therapy in Africa, it is important that AIDS-KS treatment strategies be developed that are feasible and sustainable in resource constrained areas. This application for a NIH/PEPFAR Collaboration for Implementation Science and Impact Award will establish the Strategies to Improve Kaposi' Sarcoma Outcomes (SIKO) Project. SIKO will be based on the long history of strong and productive collaborations in education and research between faculty at University of Zimbabwe College of Health Sciences (UZCHS) and the University of Colorado Denver (UCD). The SIKO Project is designed to improve outcomes in KS treatment through better early detection and treatment of KS disease and common related symptoms, in people with AIDS-KS. The overarching goal of the proposed studies is to develop evidence-based, cost-efficient approaches to improve detection and management of AIDS-KS and its related symptoms in low resource environments, and to evaluate the implementation of these approaches in primary care settings in urban and rural communities in Zimbabwe. To accomplish this goal SIKO will evaluate a novel strategy for improving treatment of AIDS-KS in Africa that is based on two principles: 1) Early detection of AIDS-KS with early initiation of antiretroviral therapy will improve treatment outcome and obviate the need for expensive and potentially toxic chemotherapy. 2) Advanced or refractory KS can be more effectively managed in Zimbabwe through decentralization of consultative specialty care to primary care settings. The SIKO strategies, if successful, will facilitate the decentralization of AIDS-KS care in Zimbabwe and will serve as a model for decentralizing medical management of other common malignancies (i.e., cervical cancer) in resource-limited settings. Although our evaluations will be conducted exclusively in Zimbabwe, given the high incidence of AIDS-KS in sub-Saharan Africa, it is likely that the knowledge gained from SIKO will be applicable to other African countries and will inform international treatment guidelines.